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What is bipolar disorder?

Bipolar disorder is an
illness that causes extreme mood changes from manic episodes of very high
energy to the extreme lows of
depression. It is also called manic-depressive
disorder.

This illness can cause behaviour so extreme that you
cannot function at work, in family or social situations, or in relationships
with others. Some people with bipolar disorder become suicidal.

About 1% of the population, or 1 out of 100 people, have
bipolar disorder.footnote 1

It's important to know that you're not alone. Talking with others who suffer from bipolar disorder may help you learn that there
is hope for a better life. And treatment can help you get back in
control.

What causes bipolar disorder?

The cause of bipolar
disorder isn't completely understood. It tends to run in families. It may
also be affected by your living environment or family situation. One possible
cause is an imbalance of chemicals in the brain.

What are the symptoms?

The symptoms depend on your
mood swings, or "highs" and "lows." During a manic high, you may feel:

Very happy, energetic, or on edge.

Like you need very little sleep.

Overly self-confident.

Some people spend a lot of money or get involved in dangerous
activities when they are manic. After a manic episode, you may
return to normal. Or your mood may swing in the opposite direction to feelings
of sadness, depression, and hopelessness. During a depressive episode, or low, you may have:

Trouble thinking and making decisions.

Memory problems.

Less interest in things you have enjoyed in the past.

Thoughts about killing yourself.

The mood swings of bipolar
disorder can be mild or extreme. They may come on slowly over several days or
weeks or suddenly over a few minutes or hours. These mood swings may last for a
few hours or for several months.

How is bipolar disorder diagnosed?

Bipolar
disorder is hard to diagnose. First, your doctor or therapist will ask detailed questions about what kind of symptoms you
have and how long they last. Your urine and blood may be tested to rule out other problems that could be causing your symptoms.

There are two types of bipolar disorder: I and II.

To be diagnosed with bipolar I disorder, you must
have had:

A manic episode lasting at least a week (or less, if you had to be hospitalized).

During that time, three or more symptoms of mania, such as needing less sleep or feeling as if your thoughts are racing.

For bipolar II disorder, your doctor will look for the same symptoms, but the manic high may be less
severe and shorter.

How is it treated?

Bipolar disorder is treatable. With treatment, which includes medicines and counselling, you can feel better.

You may need to try several medicines to find the combination that works for you.

Most people with bipolar disorder need to
take a medicine called a mood stabilizer every day.

Medicines
called antipsychotics can help get a manic phase under control.

Antidepressants are used carefully for episodes of depression,
because they cause some people to move into a manic phase.

Counselling for you
and your family is also an important treatment. It can help you cope with some
of the work and relationship issues that the illness may cause.

You can do a few things on your own to help deal with bipolar disorder. These include regular activity, getting enough sleep, and learning to recognize early signs of highs and lows.

People often stop taking their medicines during a manic
phase because they feel good. But this is a mistake. You must take your
medicines regularly, even if you are feeling better.

Cause

The cause of
bipolar disorder is not well understood, but
evidence suggests that it runs in families.footnote 2
Your living environment and family situation may also play a role. Episodes of depression and
mania may be caused by a problem with certain brain
chemicals called
neurotransmitters.

Antidepressant
medicines can trigger a manic episode in a person who has bipolar disorder. But
this may occur before the person is diagnosed, while he or
she is seeking treatment for an episode of depression.

Sleep
deprivation or substance abuse, including caffeine, can cause a person with
bipolar disorder to have a manic episode.

Not need
as much sleep as usual. (You may feel rested after 3 hours of sleep.)

Talk
more than usual.

Be more active than usual.

Have
trouble concentrating because of having too many thoughts at the same time
(racing thoughts).

Act impulsively or do reckless things, such as go on
shopping sprees, drive recklessly, or get into foolish business ventures. Or you may have
frequent, indiscriminate, or unsafe sex.

Depression may make you:

Feel sad or anxious for a significant period of
time.

Have slowed
thoughts and speech because of low energy.

Have trouble
concentrating, remembering, and making decisions.

Have changes in
eating and sleeping habits. You may eat or sleep too much or too little.

Have less interest in your usual activities, including
sex.

Have suicidal thoughts.

Types of bipolar disorder

Bipolar I. This is the classic form of the illness. It causes episodes of mania
and depression that keep coming back. The depression may last for a short time or for months. You may
then go back to feeling normal for a time, or you may go right into a manic
high.

Bipolar II. With this form, you will have depression just as in bipolar I. But the manic highs are less severe (hypomania). People with bipolar II have
more depressive lows than hypomanic highs.

Some people may have bipolar disorder with mixed
symptoms. Their highs and lows of mania and depression occur together. This makes the disorder challenging to treat and very frustrating for you and
for those around you. It can also lead to hospitalization if your daily
functioning becomes impaired.

If you have rapid-cycling
bipolar disorder, you may have at least four episodes of depression,
mania, or both within a 12-month period. You may go directly from a low to a high. Or you may have a short time lapse between
the two extreme moods.

What Happens

With
bipolar disorder, you go back and forth between highs and lows of
mania and depression. In between, you may return completely to normal
or have some remaining symptoms. The extreme mood changes may come on suddenly
or appear more slowly.

During a manic episode, you may go from feeling abnormally happy and productive to behaving irresponsibly and sleeping very little. After this manic high, your mood may return to normal. Or it may swing in the opposite direction. You may feel useless and extremely sad. And you may lose interest in things you've enjoyed in the past.

Men tend to have more manic highs, and women tend to have more lows of depression.footnote 3

At first, stress may trigger depression or
mania. But as the illness progresses, mood swings may not be caused by any
specific event. Without treatment, your bipolar disorder may get worse. This can cause
you to move more often between mania and depression.

Other health problems

People with bipolar disorder—men more often than
women—may have
substance use problems, especially during manic
episodes.footnote 4 Heavy use of alcohol or drugs may affect
treatment and interfere with taking medicines as prescribed. Other disorders
that may occur along with this disorder include:footnote 5

When To Call a Doctor

You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:

You have decided how to kill yourself, such as with a weapon or medicines.

You have set a time and place to do it.

You think there is no other way to solve the problem or end the pain.

You feel you cannot stop from hurting yourself or someone else.

Call a doctor right away if:

You hear voices.

You have been thinking about death or suicide a lot, but you do not have a plan for suicide.

You are worried that your feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

You have symptoms of depression, such as:

Feeling sad or hopeless.

Not enjoying anything.

Having trouble with sleep.

Feeling guilty.

Feeling anxious or worried.

You have been treated for depression for more than 3 weeks, but you aren't getting better.

Who to see

Bipolar disorder is complex and hard to diagnose,
because it has many phases and symptoms. Sometimes it is misdiagnosed as only
depression, because people are more likely to seek
treatment during a period of depression.

After you are diagnosed
with bipolar disorder, you'll need to keep a long-term relationship with
your doctor or therapist. It can help you make sure that your treatment is consistent and
that your medicines can be adjusted as needed.

Although your family doctor or general practitioner can diagnose bipolar disorder, you may be
referred to a
psychiatrist or mental health clinic that specializes in treating such
disorders. The psychiatrist or mental health clinic can prescribe medicines and provide counselling.

Counselling can help you deal with mood changes and the
impact bipolar disorder can have on your work and family relationships. In
addition to psychiatrists, you may be referred to other health professionals who can provide counselling, including:

Examinations and Tests

To find out if you have bipolar disorder, your doctor will ask
detailed questions about your symptoms. You will be asked how long your symptoms last and how
often you have them. Your doctor will ask about your family history and may do a
mental health assessment.

Blood and urine tests, such as a test of your
thyroid, may be done to make sure another problem isn't causing your symptoms.
A
toxicology screen looks at blood, urine, or hair for
the presence of drugs.

The earlier the disease is confirmed, the sooner you can get treatment, feel better, and improve the quality of your life. This can also reduce your risk of other health problems, such as alcohol and drug abuse.

Treatment Overview

Bipolar disorder is treated with a combination of medicines and counselling. It's important to take your medicines
exactly as prescribed, even when you feel well. Your doctor may have you try
different combinations of medicines to find what's right for you.

Your family doctor
or general practitioner can prescribe medicines to treat
bipolar disorder. But you will probably be referred to a
psychiatrist, who is trained specifically to treat
mental disorders.

Many people don't get help for bipolar disorder. You may not seek treatment because you think the symptoms aren't bad enough or that you can work things out on your own. But treatment can help you manage the highs and lows.

Your treatment plan

Treatment often starts with helping you through an "acute" phase or manic episode. You may be
suicidal or
psychotic or using such poor judgment that you are in
danger of harming yourself. Your doctor may decide that you should be hospitalized
for your own safety, especially if he or she thinks you are suicidal.

Medicines

Medicines that may be used include mood stabilizers and antipsychotics. Over time, these medicines will be adjusted with the goal of preventing manic and depressive episodes. It may
take months for your symptoms to go away and for you to be able to maintain a normal routine of work and activity. To learn more, see Medications.

Counselling

Counselling is also an important part of treatment. It can help you cope with problems that may come up in your work or relationships because of bipolar disorder. To learn more, see Other Treatment.

Self-care

You can also do some things on your own to help manage your symptoms and maintain a normal routine. Joining a support group to talk with others who have bipolar disorder can help. To learn more, see Home Treatment.

Prevention

Bipolar disorder cannot be prevented. But often the mood swings can be
controlled with medicines. And there are many things you can do for yourself to help manage highs and lows. To learn more, see Home Treatment.

Home Treatment

Home treatment is important in
bipolar disorder. There are many things you can do to help control mood swings. You don't have to do them all at once. Try to do one thing, such as eating a healthy diet, then add another when you can.

Watch what you eat

Try to eat a healthy, balanced diet. A balanced diet includes foods
from different food groups, such as whole grains, dairy,
fruits and vegetables, and protein. Eat a variety of foods from each group.
(For example, eat different fruits from the fruit group instead of only
apples.) A varied diet helps you get all the nutrients you need. No
single food provides every nutrient.

Keep good habits

Take your medicine every day as
prescribed.

Get enough exercise. Try moderate to vigorous activity for at least
2½ hours a week, if possible. A brisk walk is an example of moderate activity.

Avoid alcohol and
illegal drugs.

Limit caffeine and nicotine.

Reduce stress, get rest

Try to control the amount of
stress in your life. Techniques to relieve stress include physical activity and exercise,
breathing exercises, muscle relaxation, and counselling and support groups.

Get enough sleep. Keep your room
dark and quiet, and try to go to bed at the same time every
night. If you plan to travel into other time
zones, ask your doctor if you should make any changes in your medicines. And ask what to do if you
have a manic or depressive episode while you are away.

Ask for help

Learn to recognize the early warning signs of your manic
and depressive episodes.

Ask for help from friends and family when
needed. You may need help with daily activities if you are depressed. Or you
may need support to control high energy levels if you have a manic high.

How family and friends can help

Family members often feel helpless when a loved one is
depressed or manic. But you can help.

Encourage the person to take prescribed
medicines regularly, even when he or she is feeling good.

Recognize a lapse into a manic or depressive
episode. Help the person cope and get treatment.

Allow
your loved one to take enough time to feel better and get back into daily
activities.

Learn the difference between hypomania and when your loved one is just having a good day. Hypomania is an elevated or irritable mood
that is clearly different from a regular non-depressed mood. It can last for a
week or more.

Know the signs

Talking, writing, or drawing about death, such as writing
suicide notes.

Talking about things that can cause harm, such as
pills, guns, or knives.

Spending long periods of time
alone.

Giving away possessions.

Acting aggressive or
suddenly appearing calm.

Get help for you

If a loved one has bipolar
disorder, it may be helpful for you to get counselling to deal with its impact
on your own life. Manic episodes can be particularly hard. Talk with a
psychiatrist, a psychologist, a social worker, or a mental health counsellor
for your own therapy.

Counselling can also be helpful for a child who
has a bipolar parent. The parent's mood swings may negatively affect the child. This can cause tearfulness, anger, depression, or rebellious behaviour.

Medications

Medicines, when taken as
prescribed, can help control bipolar mood swings. Your doctor will vary the amounts and combinations of
your medicines according to your symptoms, which
type of bipolar disorder you have, and how you respond to the medicines.

About 1 out of 3 people will be
completely free of symptoms of bipolar disorder by taking
mood stabilizer medicine, such as carbamazepine or lithium, for life.footnote 5

Taking medicines during pregnancy for bipolar disorder
may increase the risk of birth defects. If you are pregnant or thinking of
becoming pregnant, talk to your doctor. You may need to keep taking medicine if
your bipolar disorder is severe. Your doctor can help weigh the risks of
treatment against the risk of harm to your pregnancy.

Medication choices

Several medicines are used to treat bipolar disorder. It
may take time to find the
treatment that works best for you. The most common medicines used are:

Mood stabilizers, such as
lithium (Carbolith, Lithane). Experts believe that lithium may affect certain brain chemicals (neurotransmitters) that cause mood changes. A mood stabilizer and an
antipsychotic are recommended as the first medicines for acute manic episodes.

Anticonvulsants, such as carbamazepine (such as
Tegretol), divalproex
(Epival), and valproate (Depakene). They are also considered mood
stabilizers. Divalproex and valproate are used to treat manic episodes. The
anticonvulsant lamotrigine (Lamictal) may be helpful for bipolar depression.

Antipsychotics, such as aripiprazole (Abilify), olanzapine (Zyprexa),
quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Zeldox). Antipsychotics improve
manic episodes. Olanzapine may be used in combination
with other medicines.

Benzodiazepines, such as diazepam (Valium). These may
be used instead of antipsychotics or as an additional medicine during a manic
phase.

Medicines and your lifestyle

When you and your doctor are
discussing your medicines, think about whether your lifestyle allows you to
take medicines on time every day. A medicine you only take once a day may work
best for you if you have a hard time remembering to take your medicines.

During your doctor's
appointment, ask about:

The side effects of each
medicine.

How often you will need to take the
medicines.

How the medicines may interact with other medicines you
are taking.

Whether it's important to take the medicines at
the same time every day.

Monitoring medicines

You'll need to check in with your doctor regularly when taking medicines for bipolar disorder.

If you are prescribed carbamazepine, lithium,
or valproate, you will need regular blood tests to monitor the
amount of medicine in your blood. Too much lithium in your bloodstream may lead
to serious
side effects. Blood tests can also help show how medicines are affecting your liver, kidneys, and thyroid gland or to measure the
number of blood cells in your body.

The use of antidepressants alone has been linked to an
increase in manic episodes. Antidepressant treatment
needs to be monitored closely to avoid causing a manic episode.

Advisories

Health Canada and the U.S. Food and Drug Administration (FDA) have
issued advisories on antidepressant medicines and the risk of suicide. It is not recommended that people stop using these medicines.
Instead, a person taking antidepressants should be watched for
warning signs of suicide. This is especially important
at the beginning of treatment or when doses are changed.

The FDA has also issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does
not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should
be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried
about this side effect should talk to a doctor.

Other Treatment

Almost all people who have
bipolar disorder need medicine. But counselling is also
important to help you cope with work and relationship struggles related to your
illness.

Counselling choices

Cognitive-behavioural therapy is a type of counselling aimed at teaching you how to become
healthier by modifying certain thought and behaviour patterns. It is based on
the theory that thought and behaviour can affect a person's symptoms and can slow or prevent recovery.

Interpersonal therapy focuses on
social and personal relationships and related problems. You and your counsellor discuss grief and
loss, role disputes in relationships, and relationship
transitions.

Problem solving is a brief, focused form
of cognitive therapy used to treat depression. It focuses on specific problems
and how you can solve them.

Family therapy is
a type of counselling used to help families deal with a stressful situation or a
life-changing event. In family therapy, each person can express any concerns
and fears about how the problem affects the person who has bipolar disorder and
the family as a whole.

No matter which type of counselling you choose, establish a long-term relationship with a counsellor you
like. The counsellor will help you recognize personality changes that show when
you are moving into a mood swing. Getting early treatment can reduce the
length of the high or low. See some tips for finding a counsellor or therapist.

ECT therapy

In some cases,
electroconvulsive therapy (ECT) may be an option. In
this procedure, brief electrical stimulation to the brain is given through
electrodes placed on the head. The stimulation produces a short seizure that is
thought to balance brain chemicals.

Alternative therapy

A few studies suggest that adding omega-3 fatty acids to medicine (such as lithium) can help reduce the depressive symptoms in some people. Omega-3 fatty acids don't seem to have any affect on the manic symptoms of bipolar
disorder. And omega-3 fatty acids alone are not a good treatment for bipolar disease. They are not a replacement for medicine or other therapy used to treat bipolar disorder.footnote 6, footnote 7

Other Places To Get Help

Organizations

Canadian Mental Health Association

www.cmha.ca

Provincial and Territorial Helplines and Websites (Canada)

Many of the resources below provide help 24 hours a day, 7 days a week in multiple languages. In an emergency, call 911.

Canada-wide resources

To find a suicide prevention crisis centre phone number or website in your province, visit the Canadian Association for Suicide Prevention's webpage at http://suicideprevention.ca/thinking-about-suicide.

To find a rape crisis or women's centre phone number or website in your province, visit the Canadian Association of Sexual Assault Centres' webpage at www.casac.ca/content/anti-violence-centres.

Kids and teens can call Kids Help Phone at 1-800-668-6868 (toll-free 24/7) or visit http://org.kidshelpphone.ca.

Emergency Social Services. During regular office hours (Monday to Friday, 8 a.m. to 5 p.m.), visit www2.gnb.ca/content/gnb/en/departments/social_development/about_us/emergency_socialservices.html to find the number for the office nearest you. After hours, call 1-800-442-9799 (toll-free).

Family Violence Outreach. Go to www.justice.gov.sk.ca/FVO for a list of community-based organizations and their contact information, or visit www.justice.gov.sk.ca/IVAP.

Child Protection.
Go to www.socialservices.gov.sk.ca/child-protection.pdf for a list of local child protection offices and their contact information, or visit http://www.socialservices.gov.sk.ca/child-protection.

Mental Health and Addictions. Go to www.health.gov.sk.ca/treatment-services-directory for a list of local alcohol and drug treatment services and their contact information, or visit www.health.gov.sk.ca/alcohol-and-drug-services.

Yukon

Provincial Health Information Line. Yukon HealthLine: Call 811 or visit www.hss.gov.yk.ca/811.php. If you are calling from a satellite phone, you can dial 1-604-215-4700 to reach the Health Services Representative at HealthLink BC.

Family and Children's Services. Call 1-867-667-3002 or visit www.hss.gov.yk.ca/family_children.php.

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